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College  of  ^frpstciang  ano  burgeon* 

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A  SURVEY  OF  THE 
PUBLIC  HEALTH  SITUATION 

ITHACA,  NEW  YORK 
1914 


BY 

FRANZ  SCHNEIDER,  JR. 
SANITARIAN 

DEPARTMENT  OF  SURVEYS  AND  EXHIBITS 

RUSSELL  SAGE  FOUNDATION 

NEW  YORK  CITY 


CENTRAL  COMMITTEE  FOR  ITHACA  SURVEY 
ITHACA,  NEW  YORK 

1915 


A  SURVEY  OF  THE 
PUBLIC  HEALTH  SITUATION 

ITHACA,  NEW  YORK 
1914 


BY 

FRANZ  SCHNEIDER,  JR. 
SANITARIAN 

DEPARTMENT  OF  SURVEYS  AND  EXHIBITS 

RUSSELL  SAGE  FOUNDATION 

NEW  YORK  CITY 


CENTRAL  COMMITTEE  FOR  ITHACA  SURVEY 

ITHACA,  NEW  YORK 
1915 


ScV.5 


CENTRAL    COMMITTEE     FOR     ITHACA     SURVEY 


Honorary  Chairman 
Chairman 

Bodies    represented 

Associated   Charities 

Board  of  Education 
Board   of  Health 

Business   Men's   Association 
Catholic    Church 
Central  Labor  Union 
Cornell  University 

Federation  of  Women's  Clubs 

Hebrew  Association: 
Jewish  Ladies'   Aid   Society 
Hebrew    Congregation 

Housewives'  League 
Industrial  Service  League 
Industrial  Survey 
Ministers'  Association 

Social   Service   League 


Mayor   Thomas   Tree 
Walter    F.    Willcox 

Representatives 
Mrs.   V.   D.   Morse 
Miss  Lillian  M.  Hoag 
Mr.    E.    H.    Bostwick 

Mrs.   G.   S.   Martin 
Prof.  V.  A.  Moore 

Dr.  I.  W.  Brewer 
Rev.   C.  W.  Heizer* 
Mr.  Bert  R.  Mitchell 

Dr.  F.  M.  Mone 
Mr.  Ysidro  Reyna 

Mr.   M.   F.   Nolan 
Mr.   F.   R.   Woolever 
Mr.  W.  J.  C.  Wismar 

Prof.  D.  S.  Kimball 
Prof.  W.  F.  Willcox 

Mrs.   F.   E.   Bates 
Mrs.  F.  A.  Mangang 
Mrs.  V.  D.  Morse 

Mrs.   J.   R.   Rothschild 
Mr.  J.   R.  Rothschild 

Mrs.   P.   A.   Fish 

Prof.  C.  V.  P.  Young 
Mr.  T.  W.  Summers 

Mr.  H.  G.  Carpenter 

Rev.  R.  T.  Jones 
Rev.  J.  A.  Macintosh 

Miss  Ada  Powell 
Prof.  J.  A.  Winans 


Executive    Committee 

Prof.  W.  F.  Willcox,   Chairman  Rev.  J.  A.  Macintosh 

Mr.  H.  G.  Carpenter  Mrs.   G.   S.    Martin 

Mrs.  V.  D.  Morse,  Secretary 


*  Deceased. 


Table  of  Contents 

Page 

Preface    3 

Introductory   note    4 

I.  Ithaca's  Public  Health   Problem    5 

II.  Vital    Statistics     6 

The    Death    Rate    6 

The    Birth    Rate     7 

Ward    Differences    7 

III.  Communicable    Diseases    8 

Typhoid    Fever     8 

Children's    Contagions    15 

Tuberculosis    16 

"Venereal    Diseases 17 

IV.  Sanitary    Conditions    18 

Wells   and   Privies    18 

City   Water    Supply    22 

Sewerage  and  Sewer  Disposal   23 

V.  City    Health    Department 24 

Organization     24 

Financial    Treatment    25 

Milk   Inspection    26 

Food    Inspection    28 

Control  of   Communicable   Diseases 29 

Infant    Mortality     30 

Publicity  and    Education    31 

Record    Keeping    31 

VI.  Summary    and    Conclusions    32 

Recommendations    32 


PREFACE 

Following  the  example  of  many  larger  cities,  a  survey  of  the  health  and 
housing  conditions  in  Ithaca  was  made  in  1914.  The  arrangements  for  the 
survey  were  in  general  charge  of  a  central  committee  under  the  honorary 
presidency  of  the  Mayor  and  including  representatives  of  the  City  Boards 
of  Education  and  Health,  the  Business  Men's  Association,  the  Federation  of 
Women's  Clubs,  the  Central  Labor  Union,  Cornell  University  and  several 
philanthropic  organizations.  This  central  committee  elected  an  executive 
committee  to  take  charge  of  the  details.  The  survey  itself  was  made  by  ex- 
perts from  out  of  town.  A  preliminary  examination  of  local  conditions  was 
made  by  Shelby  M.  Harrison,  Director  of  the  Department  of  Surveys  and 
Exhibits  of  the  Russell  Sage  Foundation,  who  spent  two  days  in  Ithaca  for 
that  purpose.  The  examination  of  health  conditions  was  made  by  Franz 
Schneider,  Jr.,  the  health  expert  of  the  same  Foundation,  and  that  of  hous- 
ing conditions  by  Miss  Udetta  D.  Brown,  who  was  recommended  to  the  local 
committee  by  the  National  Housing  Association.  University  students  in  the 
class  in  statistics  cooperated  in  preparing  many  tables  and  in  canvassing 
the  city  under  direction  of  Mr.  Schneider.  They  also  tabulated  the  living 
population  of  Ithaca  in  1910  from  a  set  of  14,802  cards  purchased  from  the 
Federal  Census  Bureau  at  Washington  and  thus  laid  the  basis  for  some 
of  the  tables  in  the  report.  Owing  to  the  difficulty  of  raising  the  amount  of 
money  needed,  it  has  been  found  possible  to  include  in  this  printed  pamphlet 
nothing  more  than  the  report  on  health  and  that  in  a  slightly  abbreviated 
form. 

The  survey  cost  in  all  about  $600,  of  which  about  half  came  from  the 
Federation  of  Women's  Clubs,  fifty  dollars  from  the  Business  Men's  Asso- 
ciation and  the  rest  through  subscriptions  from  various  individuals.  A  list 
of  those  who  have  contributed  to  the  expense  of  the  survey  will  be  found 
at  the  end  of  this  report.  To  all  in  and  out  of  Ithaca  who  have  aided  the 
committee  in  its  work  it  takes  pleasure  in  thus  publicly  expressing  its  cor- 
dial thanks. 

In  closing  its  work  the  committee  ventures  to  assure  the  interested 
public  that  the  results  reached  and  stated  by  the  visiting  experts  have  not 
been  changed  or  colored  by  them  or  us  in  the  interests  of  local  pride  or 
patriotism.  We  are  prouder  than  ever  of  Ithaca  but  are  not  blind  to  the 
need  for  improvement.  We  all  must  know  the  facts  as  they  are,  if  such 
as  need  change  are  to  be  changed. 

W.  F.  WILLCOX 
H.  G.  CARPENTER 
J.  A.  MacINTOSH 
MRS.  G.  S.  MARTIN 
MRS.  V.  D.  MORSE 
Executive   Committee. 


INTRODUCTION 

This  report  is  the  result  of  field  investigations  carried  on  by  the  author 
in  Ithaca  during  the  ten  days  ending  February  4,  1914.  The  manuscript 
of  the  report  was  transmitted  to  the  Ithaca  Central  Survey  Committee  May 
1,  1914,  but  publication  was  delayed  because  of  lack. of  funds.  As  descrip- 
tions of  local  conditions  and  recommendations  for  improvements  are  based 
on  the  situation  existing  at  the  time  of  the  investigation,  statements  in  the 
report  do  not  in  certain  instances  fit  present  conditions.  The  attempt  has 
been  made  to  note  such  changes  by  footnotes  in  the  text,  but  it  is  possible 
that  a  few  minor  changes  may  have  escaped  notice. 

The  brief  time  available  for  the  survey  prevented  intensive  investiga- 
tion of  some  of  the  more  important  public  health  problems— such  as  infant 
mortality  and  the  venereal  diseases — and  the  detailed  inspection  of  certain 
sanitary  conditions — such  as  the  sewer  system.  It  should  be  noted,  however, 
that  unusual  local  cooperation  enabled  the  survey  to  be  something  more  than 
a  rapid  running  over  of  the  situation.  Thus  it  was  possible  to  include,  through 
the  cooperation  of  Prof.  W.  F.  Willcox  and  certain  of  his  students  at  Cor- 
nell University  a  careful  enumeration  of  wells  and  privies  and  a  somewhat 
extended  discussion  of  vital  statistics.  This  cooperation  has  also  made  it 
possible  to  study  the  preventable  mortality  problems  by  ward.  Other  sub- 
jects that  are  discussed  more  fully  than  would  ordinarily  be  possible  in  the 
time  available  are  milk  supply  and  city  water  supply;  and  in  this  connec- 
tion the  author  wishes  to  make  grateful  acknowledgement  to  Professors  W.  A. 
Stocking,  Jr.,  H.   N.   Ogden,  and  E.  M.   Chamot. 

Others  to  whom  thanks  are  due  are  Dr.  Chauncey  P.  Biggs,  Dr.  I.  M. 
Unger,  Miss  L.  M.  Hoag,  City  Clerk  W.  O.  Kerr,  various  city  employees,  and 
a  number  of  members  of  the  class  in  statistics  of  Cornell  University.  The 
author  wishes  to  make  special  acknowledgement  to  Dr.  H.  H.  Crum,  health 
officer  and  now  district  sanitary  supervisor  for  the  State  Department  of 
Health,  for  his  very  hearty  and  helpful  cooperation;  and  to  Prof.  Walter  F. 
Willcox  for  the  kindest  and  most  valued  advice  and  assistance. 

FRANZ    SCHNEIDER,   JR. 
May,  1915. 


A  Survey  of  the  Public  Health  Situation  in  Ithaca 

I.  ITHACA'S  PUBLIC  HEALTH  PROBLEM 

Eleven  years  ago,  in  1903,  a  great  typhoid  epidemic  visited  Ithaca.  Close 
on  1,350  persons,  or  a  tenth  of  the  entire  population,  were  obliged  to  submit 
to  the  hazards  of  the  disease,  and  to  the  accompanying  physical  and  economic 
losses.     About    eighty-two   persons    lost    their   lives. 

This  epidemic,  caused  by  an  impure  water  supply,  was  such  a  tremendous 
object  lesson  in  the  importance  of  efficient  public  sanitation  as  to  stir  Ithaca 
to  immediate  action.  The  water  supply  was  purified  at  large  expense,  and 
the  great  excess  of  typhoid  disappeared.  Other  sanitary  improvements  were 
made;   and  the  city  settled  down  once  more  to  routine  life. 

Some  typhoid,  however,  remained.  The  records  of  the  succeeding  ten 
years  show  that  389  cases  were  reported  and  that  23  persons  died.  This 
means  an  average  of  39  cases  a  year  and  a  yearly  death  rate  of  16  per  hun- 
dred thousand  population,  an  amount  of  typhoid  that  has  been  considered 
normal  for  an  American  city  with  a  safe  water  supply,  and  one  that  com- 
monly has  been  referred  to  as  "residual."  Formerly  this  residual  typhoid 
was  regarded  as  an  unavoidable  and  somewhat  mysterious  evil;  modern  sani- 
tation, however,  shows  how  it  is  caused,  and  the  newer  methods  of  control 
are  eliminating  it. 

Ithaca's  residual  typhoid  commands  special  attention  because  it  is  typical 
of  her  general  public  health  problem.  Just  as  the  typhoid  excesses  of  1903 
and  earlier  were  eliminated  by  filtration  of  the  public  water  supply,  so  was 
her  malaria — several  thousand  cases  in  1904  and  1905 — eradicated  by  the 
extensive  works  constructed  to  drain  swampy  places.  Other  big  public  im- 
provements, already  existing  or  subsequently  constructed,  such  as  the  com- 
prehensive sewer  system  and  the  dykes  to  confine  the  several  creeks,  trans- 
formed the  city  into  an  excellent  sanitary  environment.  Doubtless  as  a  re- 
sult we  find  that  Ithaca  has  since  been  free  of  excesses  of  the  diseases  that 
spread  epidemic  by  way  of  the  inanimate  environment. 

Disease  is  spread,  however,  in  another  important  way;  that  is,  directly 
from  person  to  person  by  "contact,"  or  "contagion."  The  first  method  of 
spread,  through  the  environment  by  the  great  public  carriers,  gives  rise  to 
the  more  striking  excesses  of  disease;  these  excesses  Ithaca,  through  her 
public  improvements,  has  eliminated.  The  second  method  of  disease  spread, 
through  intimate  human  contact,  is  less  spectacular  than  the  other  but  no  less 
deadly.  It  is  the  mode  of  infection  that  contributes  heavily  to  the  "residuals," 
and  it  is  in  the  suppression  of  this  mode  that  municipal  sanitation  has  made 
perhaps  its  greatest  progress  in  the  last  decade. 

Ithaca's  public  health  problem  is,  accordingly,  that  of  a  city  which  by 
extensive  public  improvements  has  eradicated  the  great  excesses  of  pre- 
ventable   disease,    but   in   which    residuals   exist.      The    determination   of    the 


amount  and  distribution  of  these  residuals,  and  the  outlining  of  methods  for 
their  eradication,  are  among  the  prime  objects  of  this  survey.  To  attack 
these  questions  successfully  recourse  must  be  had  to  the  city's  vital  statis- 
tics— its  system  of  life  and  death  bookkeeping.  Experience  justifies  the  pre- 
diction that  the  examination  of  these  records  will  show  that  the  amounts  of 
preventable  disease  in  Ithaca,  even  though  residual,  are  well  worth  the  city's 
careful  attention. 

II.     VITAL    STATISTICS 

While  the  general  death  rate,  or  ratio  of  registered  deaths  to  population, 
is  of  itself  a  rather  unreliable  index  of  a  city's  health  history,  some  signifi- 
cant inferences  may  be  drawn  from  an  examination  of  the  Ithaca  rate.  Taking 
the  deaths  for  the  years  1908  to  1912  and  the  population  of  1910  as  a  basis, 
the  city's  death  rate  averages  16.2  per  thousand  population.  Compared  with 
New  York  State  as  a  whole  this  rate  is  favorable;  and  the  advantage  is  main- 
tained at  nearly  all  ages  of  life,  as  is  shown  in  the  table  below. 

COMPARISON    OF    DEATH    RATES    FOR    VARIOUS    AGE    GROUPS, 
ITHACA   AND   NEW   YORK   STATE,   1908-1912* 


Age  group 

Ithaca 

New  York  State 

In  excess 

0-1 

113.0 

144.0 

State 

1-4 

13.7 

17.3 

State 

0-4 

32.9 

44.2 

State 

5-9 

4.6 

3.9 

Ithaca 

10-14 

1.6 

2.4 

State 

15-19 

4.6 

3.7 

Ithaca 

20-24 

6.7 

5.2 

Ithaca 

25-29 

6.9 

6.4 

Ithaca 

30-34 

6.5 

7.8 

State 

35-39 

6.3 

9.7 

State 

40-44 

7.7 

11.9 

State 

45-49 

12.5 

14.9 

State 

50-54 

14.7 

19.2 

State 

55-59 

22.3 

27.1 

State 

60-64 

28.1 

37.6 

State 

65-69 

49.7 

53.7 

State 

70-74 

71.9 

76.9 

State 

75-79 

103.0 

110.7 

State 

80-84 

154.0 

166.2 

State 

85-Over  226.0  264.0  State 

In  the  only  age  groups  having  the  city  rates  in  excess,  those  of  yougg 
people,  the  differences  are  slight  and  the  numbers  involved  too  small  to  give 
the  indication  much  weight.  The  examination  of  Ithaca's  death  rate  is,  there- 
fore, reassuring,  an  impression  that  will  be  strengthened  by  the  study  of  her 
death  rates  from  specific  communicable  diseases. 


•  Figures   furnished    by   Prof.    W.    F.    Willcox. 

6 


An  examination  of  the  city's  death  and  birth  rates  by  wards,  such  as  is 
given  in  the  table  below,  sheds  an  interesting  light  on  conditions  in  Ithaca. 
The  differences  in  the  ward  death  rates,  which  range  from  9.3  in  Ward  Four  to 
17.1  in  Ward  Two,  are  probably  to  a  considerable  degree  the  result  of  differ- 
ences in  the  age  and  sex  distribution  of  the  population;  they  are,  however,  es- 
pecially interesting  in  connection  with  the  birth  rate  variations. 

DEATH    RATE  AND   BIRTH    RATE   BY  WARDS,   ITHACA 
Mortality  figures  for  1909-1911;    birth   rate  for  1911 


Population 

Averagi 

i  annual 

num- 

Death   rate1 

Birth   rate" 

Ward 

July  1,  1910 

ber 

of  death 

sa 

per  1,000 

per  1,000 

1 

2,578 

41 

16.0 

25.6 

2 

2,481 

42 

17.1 

14.9 

3 

2,741 

45 

16.4 

15.3 

4 

3,375 

31c 

9.3 

12.4 

5 

3,662 

41 

11.2 

15.0 

City 

14,837 

200 

13.5 

16.3 

While  these  ward  figures  illustrate  the  general  correspondence  between  a 
high  birth  rate  and  a  high  death  rate,  and  while  it. should  be  remembered  that 
the  rates  are  not  for  identical  periods  of  time,  it  is  worthy  of  note  that  in 
Wards  Two  and  Three  the  death  rate  actually  exceeds  the  birth  rate.  This 
fact  is  doubtless  accounted  for  by  the  presence  of  an  abnormal  proportion  of 
old  persons  in  the  populations  of  these  wards.  The  relatively  high  birth  rate, 
and  the  corresponding  higher  rate  of  natural  increase,  in  Ward  One,  which  em- 
braces the  West  Hill  and  Inlet  district,  is  similarly  to  be  accounted  for  by  the 
relatively  young  and  foreign  population  living  in  that  part  of  the  city. 

Most  interesting  in  connection  with  these  ward  variations,  and  decidedly 
more  significant  from  a  public  health  standpoint,  are  the  variations  in  ward 
mortality  from  certain  of  the  big  preventable  causes.  Ward  rates  for  tubercu- 
losis and  pneumonia,  two  of  the  most  important  diseases  that  come  within  the 
range  of  preventive  measures,  are  shown  in  the  table  'below,  and  it  is  evident 
that  marked  excesses  occurred  in  Wards  One  and  Three — the  districts  around 
the   Inlet. 


a  Residents   only. 

b  Includes    20    unregistered    births. 

c  Deaths  of  two  students  are  included  in  the  figures  for  Ward  Four.     The  population 
figures,    however,    do    not   include   students. 


DEATH  RATES  FROM  TUBERCULOSIS  AND  PNEUMONIA  BY  WARDS, 

ITHACA,   1904-1913 

Average  yearly   rates  per   100,000   population.      Residents  only. 
Ward  Tuberculosis  Pneumonia  Total 

1  169.7  173.6  343.3 

2  90.2  114.8  205.0 

3  148.4  178.1  326.5 

4  •  57.3  79.4  136.7 

5  50.0  91.7  141.7 
City                                   97.4                                      122.7                              220.1 

The  conclusions  to  be  drawn  from  this  brief  inspection  of  the  city's  vital 
statistics  are  that  while  the  showing  is  on  the  whole  good  marked  variations 
in  mortality  occur,  that  the  city's  hygienic  problem  centers  in  the  west  side 
and  the  lowlands  around  the  Inlet,  and  that  in  these  last  districts  serious  life 
and  health  losses  occur  from  preventable  causes.  These  conclusions  are  con- 
sistent with  those  drawn  from  the  studies  of  typhoid  fever  and  sanitary  con- 
ditions, which  are  to  be  found  later  in  this  report. 

It  should  be  noted  in  passing  that  there  is  reason  to  believe  that  regis- 
tration of  births  in  Ithaca  is  incomplete.  The  City  Clerk's  records  show  222 
births  registered  in  1911.  For  the  same  year,  Miss  Elma  E.  Cummings  and 
Miss  Margaret  B.  Cornell,  of  Cornell  University,  working  under  the  direction 
of  Professor  Walter  F.  Will  cox,  discovered,  by  consulting  baptismal  records 
and  by  house-to-house  canvass,  20  births  that  were  unregistered.  In  other 
words,  not  more  than  91.7  per  cent  of  the  births  were  registered.  This  pro- 
portion is  unquestionably  better  than  that  prevailing  throughout  the  state  as 
a  whole,  and  is  inferior  only  to  that  in  some  of  the  larger  cities;  omission  of 
registration  is,  however,  contrary  to  law  and  often  embarrassing  to  the  indi- 
vidual in  later  life,  while  something  near  perfection  should  be  attainable. 
Strengthening  the  city's  health  service,  as  recommended  later  in  this  report, 
would  do  much  to  eliminate  this  deficiency. 

III.      COMMUNICABLE    DISEASES 

Typhoid    Fever 

Turning  now  to  a  more  intensive  study  of  the  principal  communicable 
diseases,  first  consideration  appropriately  may  be  given  to  typhoid  fever. 
Not  only  is  it  a  serious  disease,  but  its  persistence  in  Ithaca  is,  as  we  have 
seen,  typical  of  the  city's  public  health  problem.  For  these  reasons  a  care- 
ful examination  of  its  recent  history  is  especially  important.  The  distribu- 
tion of  cases  by  ward,  for  the  last  three  years  is  given  below. 


CASES    OF    TYPHOID     FEVER     BY    WARD,    ITHACA,    1911-1913:' 


Ward 


Number 

Per  cent 

of  cases 

of  total 

40 

41.6 

10 

10.4 

18 

18.8 

4 

4.2 

24 

25.0 

Per  10,000 

population 

per  year 

50.6 

13.1 

21.4 

3.9 

21.4 


Total  '    96  100.0  21.1 

The  figures  in  the  last  column,  representing  cases  per  10,000  population, 
bring  out  the  comparative  prevalence  of  the  disease  in  different  parts  of  the 
city,  and   show  that  very  marked  variations  exist.     Ward  One  has  obviously 

MAP  I. 


LOCATION  OF  CASES  OP  TYPHOID  FEVER,  ITHACA,  1911-1913 
Note  the  clustering  of  cases  (114  in  all)  and  the  preponderance  of  the  disease  in 
the  northern  and  western  parts  of  the  city.  The  open  circles  represent 
imported  or  student  cases.  Ithaca's  typhoid  is  "residual" — about  what  is 
ordinarily  to  be  found  in  a  city  with  a  safe  water  supply ;  but  it  can  be,  and 
should    be    eliminated. 

suffered  far  more  severely  than  the  other  wards,  having  over  twice  the  rate 
occurring  in  the  next  worst  ward  and  over  twelve  times  that  in  the  best 
ward.  Map  1  indicates  the  more  exact  location  of  these  cases,  which,  it  will 
be  observed,  are  chiefly  in  the  west  side  and  Inlet  districts. 


a  This  table  does  not  include  18  imported  or  student  cases,  which  were  distributed 
as  follows:  one  case  in  Ward  One;  11  cases  in  Ward  Four;  six  cases  in 
Ward    Five. 


The  variations  in  prevalence  of  typhoid  seen  above  are,  in  this  age,  quite 
unnecessary,  and  are  a  positive  indication  that  things  are  not  as  they  should 
be  in  Ithaca.  Typhoid  is  an  infectious  and  preventable  disease,  which  can  be 
acquired  only  by  taking  through  the  mouth  part  of  the  bowel  or  bladder  dis- 
charges of  a  previous  patient.  Certainly  here  is  a  circumstance  that  the  com- 
munity should  be  able  to  prevent,  and  which  it  does  prevent  in  most  English 
and  German  cities. 

One  significant  piece  of  evidence  as  to  the  source  of  Ithaca's  residual 
typhoid  is  offered  by  a  comparison  of  the  distribution  of  cases  with  that  of 
wells  and  privies.  The  table  below  gives  this  comparison  as  between  cases 
occurring  in  the  last  three  years  and  wells  and  privies  as  enumerated  in 
January,  1914. 

DISTRIBUTION   OF  TYPHOID  CASES,  WELLS,  AND   PRIVIES,   ITHACA 


Per  cent  of 

Per  cent 

of 

Per 

cent  of 

wells,  1914 

privies,  1914 

typhi 

Did  cases 

Wards 

1911-1913 

1 

36.4 

46.2 

41.6 

2 

15.2 

12.7 

10.4 

3 

16.8 

18.8 

18.8 

4 

4.3 

4.3 

4.2 

5 

27.3 

18.0 

25.0 

Total  100.0  100.0  100.0 

Clearly  there  is  a  remarkable  correspondence  between  the  proportion  of 
wells  and  privies  and  the  proportion  of  typhoid  fever.  Ward  One  has  about 
40  per  cent  of  the  wells  and  privies  and  a  little  more  than  40  per  cent  of 
the  typhoid;  Ward  Four  has  four  per  cent  of  the  former  and  four  per  cent 
of  the  latter;  and  the  other  wards  show  nearly  as  close  a  correspondence. 
Typhoid  evidently  lingers  where  wells  and  privies  remain  in  use;  and  the 
first  condition  is  undoubtedly  very  much  a  result  of  the  second.  Further  evi- 
dence against  the  privy-well  combination,  and  in  exoneration  of  the  city  water 
supply,  is  offered  by  an  examination  of  the  case  histories  of  typhoid  as  re- 
corded at  the  city  health  department  to  ascertain  what  water  the  patient 
had  been  drinking.     This  information  for  the  last  three  years  is  shown  below. 

POSSIBLE    SOURCES   OF    RESIDUAL   TYPHOID,    ITHACA,    1911-1913 


Number  of 

cases 

Per 

cent  of  total 

City  water  used 

6 

5.3 

Well  water  used 

82 

71.9 

Water  used  unknown 

8 

7.0 

Imported  or  students 

18 
114 

15.8 

Total 

100.0 

10 

Thus  72  per  cent  of  all  persons  having  the  disease  used  well  water  as 
against  5  per  cent  using  the  city  supply.  At  the  time  of  the  great  epidemic 
of  1903,  before  the  installation  of  the  filter  plant,  those  using  the  city  sup- 
ply were  attacked,  those  using  well  water  for  the  most  part  escaped.  As 
a  result  confidence  in  wells  was  engendered,  and  this  feeling  has  persisted. 
Now,  however,  it  must  be  emphasized  that  circumstances  are  reversed,  that 
the  city  supply  shows  by  far  the  smaller  proportion  of  cases,  and  that 
wells  are  relatively  deserving  of  suspicion. 

While  a  good  part  of  Ithaca's  residual  typhoid  is  undoubtedly  chargeable 
to  wells  and  privies,*  and  would  disappear  with  the  elimination  of  these  sanitary 
makeshifts,  it  would  be  an  error  to  assume  that  each  and  every  case  of  the 
disease   listed    above    as    using   well    water   is    directly   attributable    to    these 


I  CASE 


A-  CASES      3CHSZS 


ITHACA'S    RESIDUAL    TYPHOID 
Triangular  block  near  Lehigh  Valley  station.     Eight  cases  occurred  during  September 
and    November    of    1912    in    the    three    houses    indicated.      Direct    contact    from 
person    to    person    played    an    important    part    in    the    causation    of    this    little 
outbreak, 
sources.     A   considerable   number   are    "secondary;"    that   is,   due   to   personal 
contact  with  a  victim  of  the  disease.     Thus  of  the  114  cases  occurring  in  the 
last  three  years  28  were  so   considered;    in  other  words,  24.6  per  cent  of  all 
cases,  or  29.2  per  cent  if  imported  and   student  cases  be  excluded,  were  at- 
tributed  to    secondary    infection.      These    cases    arise    from    lack    of    efficient 
bedside  disinfection  of  the  patient's  discharges. 

To  test  out  this  indication  of  the  importance  of  secondary  infection  the 
case  histories  as  furnished  by  the  health  officer  were  subjected  to  intensive 
study.     It  was  readily  apparent  that  in  each  of  the  three  years  under  consid- 


*  For    further    discussion    of    the    dangers    from    wells    and    privies    and    the    situation 
in   Ithaca,   see  pages   18-19. 

11 


eration  the  localization  of  cases  iwas  very  marked,  little  district  outbreaks 
taking  place,  which  while  slower  in  progress  and  more  restricted  in  scope 
than  water  or  milk  home  epidemics  are  just  as  fatal  to  those  attacked.  In 
1911  the  disease  centered  around  the  so-called  Pottery  Building  in  Ward  Five, 
in  1912  around  a  small  triangular  block  near  the  Lehigh  Valley  Station,  and  in 
1913  around  two  houses  on  Cliff  Street.  The  detailed  histories  of  these  out- 
breaks were  reconstructed  as  far  as  possible,  and  one  of  them  is  given  below 
hy  way  of  illustration.  It  should  be  remembered  that  the  incubation  period 
of  typhoid — 'that  elapsing  between  infection  and  the  appearance  of  marked 
symptoms,  is  albout  two  weeks,  and  that  patients  may  be  infectious  from  the 
early  stages  well  through  convalescence. 

Typhoid  Outbreak  of  1912  Around  the  Lehigh  Valley  Station 

This  series  of  cases  started  in  September  at  319  Westport  Street,  with 
two  children  named  Lovell.  The  source  of  their  disease  is  not  positively 
known,  although  it  is  said  they  drank  Inlet  water  from  a  well  near  its  edge. 

On  September  14th,  a  man  named  Bagley  came  down  with  the  disease 
at  1002  West  State  Street,  in  a  house  located  at  the  southeast  corner  of  a 
small  triangular  block  about  200  feet  on  each  side.  At  the  time  of  the  sur- 
vey this  little  block  contained  eight  houses,  five  privies,  and  eight  wells.  The 
privies  and  wells,  being  in  the  rear  of  the  houses,  abut,  and  there  is  ample 
opportunity  for  pollution  of  the  wells  and  for  flies  to  carry  infection  from  the 
privies.  At  all  events,  eleven  days  after  the  Bagley  case  two  'children  named 
Fatula,  living  in  the  same  triangular  block,  at  903  West  Buffalo  Street,  were 
taken    sick. 

Back  on  Westport  'Street  in  the  meanwhile  at  327,  Fred  Letts,  aged  11, 
and  in  close  contact  with  the  Lovell  cases,  developed  the  disease  on  September 
25th,  to  be  followed  at  the  same  address  on  November  5th  by  Lillle  Lovell, 
mother  of  the  two  original  cases. 

Returning  to  the  triangle  block,  we  find  that  on  November  6th,  eleven 
days  after  the  first  Fatula  cases  were  reported,  Dora  Lynch,  living  next 
door  at  905  West  Buffalo,  had  contracted  the  infection.  On  November  22nd, 
Mike  Fredorka,  and  at  about  the  same  time  little  John  Fatula,  were  reported 
from  the  original  Fatula  house.  Finally,  on  November  23rd,  the  mother  and 
eight-year-old  sister  of  Dora  Lynch  developed  true  cases. 

Two  other  cases  appeared  in  the  neighborhood:  Andrew  Molloch,  aged 
twenty-nine,  on  October  26th,  at  306  Brindley  Street;  and  Mary  Clark,  aged 
seven,  on  November  15th,  at  316  Brindley.  Altogether  this  series  represents 
14  cases,  of  which  nine  were  in  all  probability  secondary.  All  the  persons 
involved  drank  well  water  and  all  used  privies. 

The  stories  of  the  outbreaks  of  1911  and  1913  are  much  the  same:  a 
primary  case  or  two  followed  by  a  series  of  others  in  the  same  family  or 
immediate  neighborhood,  the  cases  following  each  other  in  about  the  incubation 
period  of  the  disease.  The  1911  outbreak  included  twelve  cases  of  which 
at  least  half  were  contracted  through  personal  contact.  The  Cliff  Street 
group  of  1913  gave  ten  cases,  nine  in  two  houses,  and  seven  in  all  probability 
secondary.  Together  these  three  outbreaks  contributed  36  cases — about  one- 
third  of  all  cases  reported  in  the  three  years.     The  investigation  also  showed 

12 


that  the  outbreaks  were  a  considerable  expense  to  the  city,  not  only  in  the 
matter  of  furnishing  supplies,  disinfecting  material  and  supervision,  but  in 
the  hospital  care  of  a  considerable  number  of  persons.  In  other  instances, 
the  disease  forced  families  to  apply  for  aid  at  the  Associated  Charities. 

The  existence  of  this  secondary  typhoid  is  a  striking  testimonial  of  the 
inability  of  some  people  to  care  for  cases  of  typhoid  at  home  without  danger 
to  themselves  and  others,  and  of  the  inability  of  the  city  health  department, 


ITHACA'S    RESIDUAL    TYPHOID 

512  Cliff  Street,  where  four  cases  occurred  in  September,  1913.  Two  of  these  cases 
were  secondary,  home  conditions  rendering  proper  care  of  the  patients  and 
efficient  disinfection  of  their  discharges  quite  impossible.  The  well  had  been 
condemned  by  the  health  officer  but  was  found  in  use  (January,  1914).  Note 
the  opportunity  for  its  pollution  from  the  buildings  above. 

as  at  present  equipped,  to  break  up  the  chain  of  infection.  When  it  is  clear 
that  home  conditions  do  not  ensure  efficient  ibedside  disinfection  of  the  pa- 
tient's discharges  and  reasonable  safety  to  other  members  of  the  family  and 
the  neighborhood,  the  patient  should  he  removed  to  a  hospital.  Families  are 
sometimes  unwilling,  however,  to  have  members  removed,  and  the  health  of- 
ficer doubted  whether  removal  could  be  enforced  in  such  cases.  The  State 
Commissioner  of  Health,  in  reply  to  inquiry  on  this  point,  gave  an  opinion, 
however,  that  a  local  ordinance  could  be  enacted  to  remove  a  case  of  typhoid 


13 


or  any  other  disease  where  in  the  judgment  of  the  health  officer  it  was  neces- 
sary. The  matter  is  evidently  one  in  which  the  city  should  determine  its 
power.  While  in  most  cases  a  trained  and  regularly  employed  health  depart- 
ment nurse,  working  under  the  direction  of  the  health  officer  can,  'by  in- 
struction and  re-instruction,  see  that  other  members  of  the  family  and  neigh- 
borhood are  protected  from  infection,  cases  will  arise  in  which  power  of  re- 
moval is  needed,  and  in  which  it  should  be  exercised. 

Such  is  the  story  of  Ithaca's  "residual"  typhoid.  It  occurs  almost  en- 
tirely in  districts  where  privies  and  wells  are  still  used,  and  the  foundation 
for  much  of  it  doubtless  would  be  removed  by  the  elimination  of  these  con- 


ITHACA'S  RESIDUAL,  TYPHOID 
221  Cliff  Street,  the  house  to  the  left.  Five  cases  occurred  here  during  October, 
1913,  to  January,  1914,  and  a  sixth  case  probably  was  contracted  here.  Ithaca's 
wells  and  privies  should  be  eliminated  as  rapidly  as  possible  and  the  health 
department  should  be  given  public  health  nurses  to  exercise  adequate  super- 
vision over  cases  of  typhoid.  Patients  should  be  removed  to  a  hospital  when 
they  cannot  be  cared  for  at  home  with  safety  to  their  family  and  the  neigh- 
borhood. 

veniences.  A  considerable  part  of  it,  perhaps  a  third,  is,  at  the  same  time, 
due  to  personal  contact  with  patients — to  imperfect  disinfection  of  the  pa- 
tients' discharges.  The  remedy  for  the  latter  condition  obviously  is  closer 
supervision  of  cases  by  the  health  department,  a  state  of  affairs  that  re- 
quires more  liberal  financial  resources  for  the  department,  but,  fortunately, 
no  very  great  expenditure.  While  the  total  amount  of  typhoid  remaining  in 
Ithaca  is  not  large,  as  things  go  in  this  country,  it  can  be  much  reduced, 
or  nearly  obliterated.  The  residual  cases  are  a  menace  to  the  rest  of  the 
city,  and  probably  are  more  expensive  to  care  for  after  they  develop  than 
to  prevent. 


14 


Children's    Contagions 

Ithaca  has  in  the  last  few  years  come  off  fortunately  with  regard  to  the 
contagious  diseases  of  children.  As  will  he  seen  from  Table  A,  the  amounts 
of  scarlet  fever,  diphtheria,  and  whooping  cough  have  been  small;  and  except 
for  an  epidemic  of  the  diffioult-tc~restriet  measles  in  1911,  the  record  of  the 
last  few  years  has  been  gratifying.  The  essential  points  to  be  observed  in 
combating  these  diseases  are  similar  to  those  necessary  for  the  elimination 
of  secondary  typhoid;  that  is,  early  reporting  of  cases  and  efficient  bedside 
disinfection,  with  increased  emphasis  here  on  actual  isolation  of  the  patient. 
Discussion  of  the  procedures  now  used  in  Ithaca  may  be  found  on  pages  29-30; 
for  the  present  it  is  sufficient  to  note  that  to  continue  the  good  record 
of  the  last  few  years  the  health  department  must  have  the  active  co-opera- 
tion of  parents.  It  is  to  the  advantage  of  all  that  cases  be  recognized  as 
early  as  possible,  that  they  be  reported  to  the  health  department  promptly, 
and  that  efficient  isolation  be  maintained. 

TABLE    A 
COMMUNICABLE  DISEASES  IN   ITHACA,  1904-1913 


Year 

Typhoid 

Fever 

Tuberci 

ilosis 

Pneumonia 

Diphth 

eria 

Cases 

Deaths 

Cases 

Deaths 

Cases 

Deaths 

Cases 

Deaths 

1904 

15 

3 

— 

17 

— 

29 

10 

0 

1905 

30 

1 

10 

18 

— 

16 

5 

1 

1906 

39 

3 

— 

17 

— 

16 

32 

1 

1907 

13 

0 

— 

20 

— 

13 

173 

8 

1908 

43 

1 

— 

16 

— 

10 

44 

9 

1909 

92 

4 

12 

12 

— 

10 

21 

4 

1910 

43 

4 

10 

14 

— 

20 

c 

0 

1911 

40 

2 

24 

14 

23 

20 

8 

0 

1912 

42 

3 

46 

10 

— 

23 

1 

0 

1913 

32 

2 

62 

9 

— 

25 

1 

1 

Total 

389 

23 

164 

147 

23 

182 

300 

24 

Scarlet 

Fever 

Meas 

les 

Influenza 

Whooping 

Cough 

Cases 

Deaths 

Cases 

Deaths 

Cases 

Deaths 

Cases 

Deaths 

1904 

3 

1 

368 

4 

2 

5 

— 

0 

1905 

2 

0 

— 

0 

— 

3 

— 

0 

1906 

2 

0 

— 

0 

— 

1 

— 

0 

1907 

47 

1 

— 

0 

— 

4 

— 

0 

1908 

101 

1 

— 

0 

— 

6 

'  — 

0 

1909 

93 

1 

— 

0 

— 

2 

— 

0 

1910 

47 

2 

25 

0 

— 

4 

— 

0 

1911 

28 

1 

361 

4 

— 

5 

31 

1 

1912 

28 

0 

28 

0 

— 

2 

30 

1 

1913 

12 

0 

21 

0 

— 

5 

— 

0 

Total 


363 


793 


37 


81 


15 


Malaria  Syphilis  Paresis     Locomotor  ataxia 

Cases  Deaths  Deaths  Deaths  Deaths 

1904  2000  [?]  1  0  1  0 

1905  1000  [?]  10  0  1 

1906  —  1  0  0  1 

1907  —  0  1  1  0 
190S                     —                          0                        1                        0                        1 

1909  —  0  0  0  0 

1910  —  2.0  1  0 

1911  110  1 

1912  —  1  2  2  0 

1913  —  0  0  1  0 

Total  3000  [?]  7  5  6  4 

Tuberculosis 

Ithaca's  tuberculosis  problem  is  in  many  respects  similar  to  its  typhoid 
problem.  A  general  decline  in  the  mortality  from  this  cause  during  the  last 
ten  years  is  evident  from  inspection  of  Table  A.  The  rate  per  hundred  thou- 
sand population  averages  98  for  the  decade,  which  is  low  in  comparison  with 
most  urban  communities,  and  for  1913  it  is  only  58.7,  an  exceedingly  low  figure. 

The  distribution  of  mortality  throughout  the  city  has  not  been  uniform,  as 
was  seen  from  the  table  on  page  8,  the  rate  for  the  decade  varying  from 
50  in  Ward  Five  to  170  in  Ward  One.  The  disease  has  been  most  prevalent 
in  the  Inlet  district.  The  table  below,  showing  the  distribution  by  ward  of 
cases  now  in  the  register,  gives  the  same  general  indication.  The  minor  dif- 
ferences in  the  ward  proportions  as  shown  by  the  mortality  figures  and  those 
for  cases  registered  may  mean  that  the  present  case  investigation  work  is  be- 
ing prosecuted  more  intensely  in  some  parts  of  the  city,  or  simply  that  preva- 
lence in  the  various  districts  has  undergone  a  change.  At  all  events,  it  is 
evident  that  certain  parts  of  the  city  present  serious  tuberculosis  problems, 
and  that  the  usual  restrictive  measures  are  needed. 

TUBERCULOSIS   CASES    REGISTERED,    BY   WARD 
ITHACA,    JANUARY,    1914 
Ward 


City  140  100.0  9.1 

16 


Number 

Per  cent 

Per  1,000 

of  cases 

of  total 

population 

40 

28.6 

14.9 

13 

9.3 

5.0 

27 

19.3 

9.5 

26 

18.5 

7.4 

34 

24.3 

8.9 

Examination  of  Table  A  shows  not  only  that  the  mortality  from  tuberculosis 
is  on  the  decline,  but  that  a  great  improvement  in  the  reporting  of  the  disease 
has  taken  place  in  tlhe  last  few  years.  This  is  undoubtedly  a  result  of  the 
work  of  the  tuberculosis  nurse.  Ithaca's  tuberculosis  campaign  started  in  Au- 
gust, 1911,  when  the  Tuberculosis  Committee,  aided  by  an  appropriation  of 
$200  from  city  funds,  opened  a  dispensary.  No  permanent  staff  was  employed, 
however,  and  as  people  did  not  appear  for  treatment  or  advice,  it  seemed  that 
the  enterprise  would  fail.  In  November  of  the  same  year  the  present  nurse  was 
engaged  on  full  time,  and  soon  showed  the  wisdom  of  her  appointment  by 
quickly  discovering  cases  and  attracting  them  to  the  dispensary.  The  work 
in  the  first  few  months  was  largely  in  the  hands  of  the  Committee,  but  as  the 
real  need  for  the  service  became  apparent,  the  city  took  it  over  and  now  em- 
ploys the  nurse. 

At  the  present  time  the  nurse  seems  to  have  the  interest  and  co-opera- 
tion of  patients  and  doctors,  and  a  comprehensive  program  is  under  way.  Two 
day  clinics  and  one  evening  clinic,  attended  by  three  relays  of  four  doctors, 
are  held  each  week;  patients  are  given  record  books,  thermometers,  and  milk 
tickets,  and  their  sleeping  is  supervised.  A  Saturday  afternoon  children's 
class  was  organized  January  1,  1914,  and  a  preventorium  to  build  up  weakly 
children  has  been  incorporated.  In  addition  the  city  and  county  maintain,  at 
Taughannock  Falls,  the  Edward  Meany  Sanatorium,  an  Institution  with  a  ca- 
pacity of  17,  which  at  the  time  of  the  survey  was  accommodating  15  Ithaca 
cases.  Plans  have  been  prepared  for  enlargement,  which  is  certainly  neces- 
sary to  meet  the  proper  demands  of  city  and  county.  The  nurse  now  has  a 
waiting  list  of  two  or  three  cases,  while  the  county  cases  go  almost  entirely 
without  treatment. 

Altogether  the  city  may  be  congratulated  on  having  under  way  a  well- 
rounded  tuberculosis  program.  The  reporting  of  cases  seems  excellent,  there 
being  at  present  107  cases  in  the  register.  The  needs  of  the  situation  are  in 
the  nature  of  amplification;  a  larger  room  for  the  clinic,*  mere  nursing  service, 
and  the  enlargement  of  the  sanatorium  according  to  present  plans. § 

Venereal    Diseases 

Intensive  investigation  of  the  prevalence  of  the  venereal  diseases — syphilis, 
chanchroid,  and  gonorrhoea,  was  not  possible  in  the  time  available  for  the  sur- 
vey. It  must  not  be  concluded,  however,  that  these  diseases  are  relatively 
unimportant.  As  a  matter  of  fact,  if  normally  prevalent  in  Ithaca,  they  are 
among  the  most  serious  communicable  maladies  that  afflict  the  community. 
Caused  by  specific  micro-organisms,  these  diseases  are  infectious  and  preventa- 
ble. Rapid  strides  have  been  made  in  recent  years  in  their  laboratory  diagno- 
sis and  successful  treatment,  and  useful  prophylactics  are  at  hand.  Altogether 
they  cause  much  suffering,  loss  of  efficiency,  and  premature  death  in  middle 
age.  One  of  them,  syphilis,  is  now  regarded  as  the  cause  of  the  large  ma- 
jority of  cases  of  paresis  and  locomotor  ataxia;  and  another,  gonorrhoea,  is 
responsible  for  much  blindness  and  much   sickness  among  women. 


*  This  need  is  now  met. 


§  The  sanatorium  has  been  enlarged  and  now  accommodates  27. 

17 


Reliable  information  as  to  the  prevalence  of  these  diseases  is  difficult  to 
obtain.  Almost  all  the  doctors  and  social  workers  know  of  cases,  but  exact 
figures  are  not  available,  as  the  community  officially  ignores  the  problem. 
One  well-informed  physician  answered  an  inquiry  on  the  subject  in  the  fol- 
lowing words: 

"In  reply  to  your  letter  of  February  10,  1914 — I  am  not  prepared  to 
give  you  much  information  about  venereal  disease — not  being  a  spec- 
ialist and  simply  knowing  about  what  I  consider  is  a  small  per  cent  of 
cases  that  are  here.  Most  every  doctor  here  treats  these  diseases — 
especially  gonorrhoea  of  which  I  have  treated  exactly  six  (6)  in  tlhe 
past  five  (5)  months.  I  have  had  two  (2)  cases  of  syphilis  in  the  same 
period,  one  still  here,  one  sent  home.  I  am  well  aware  that  this  is 
about  half  the  number  of  cases  seen  last  year  by  me — and  I  also  know 
that  this  number  multiplied  by  the  number  of  doctors  here  would 
hardly  give  you  an  approximate  number  of  the  cases." 

We  may  note  also  that  in  the  last  decade,  as  is  shown  in  Table  A,  five  deaths 
have  been  recorded  as  due  to  syphilis,  six  to  paresis,  and  four  to  locomotor 
ataxia;  and  it  must  be  remembered  that  venereal  diseases  are  seldom  given 
as  the  cause  of  death  when  any  other  cause  can  be  certified. 

On  the  whole,  therefore,  there  is  no  reason  for  doubting  that  Ithaca,  has 
her  share  of  these  diseases,  for  the  restriction  of  which  rational  procedures 
exist  ready  to  be  applied  once  the  community  decides  that  the  diseases  shall 
be  prevented.  Oases  should  be  reported  to  the  health  department,  by  number 
instead  of  name  if  so  desired,  free  laboratory  diagnosis  should  be  offered  phy- 
sicians (the  presence  of  the  University  Laboratories  is  here  a  simplifying  fac- 
tor), free  treatment  should  be  offered  indigent  sufferers,*  and  educational  work 
should  be  carried  on.  The  discovery  and  cure  of  infectious  cases  of  venereal 
disease  is  one  of  the  most  important  possibilities  in  a  health  department  dis- 
pensary service,  such  as  is  suggested  on  page  30  of  this  report.  At  all  events 
Ithaca  should  charge  her  health  department  with  the  study  and  prevention 
of  these  diseases. 

IV.     SANITARY   CONDITIONS 

Wells  and  Privies 

A  careful  enumeration  of  Ithaca's  wells  and  privies  was  made  possible 
through  the  co-operation  of  Professor  W.  F.  Willcox  and  students  from  his 
class  at  the  University.  The  city  was  divided  into  districts  and  a  house-to- 
house  convass  made.  As  is  generally  the  case,  investigation  proved  the  esti- 
mates of  local  persons  to  be  very  much  short  of  the  actual  numbers.  Thus  some, 
of  the  city  authorities  estimated  that  there  might  be  200  private  wells;  as 
a  matter  of  fact  there  proved  to  be  954.  The  distribution  of  the  wells  and 
privies  is  indicated  in  Maps  2  and  3  and  in  the  tables  below. 


*  The  Board   of  Health   has   since  passed   a   resolution  whereby   indigent   persons  with 
syphilis    may    have    prescriptions    filled    free. 

18 


PRIVATE   WELLS,    ITHACA,   JANUARY,   1914 
Ward  Number 


1 

2 
3 

4 
5 

City 


347 
145 
160 
41 
261 

954 


Per  cent 

Per  1,000 

of  total 

population 

36.4 

129 

15.2 

56 

16.8 

56 

4.3 

12 

27.3 

69 

100.0 


62 


MAP  II. 


LOCATION    OF    WELLS,    ITHACA,    JANUARY,    1914 
A    house-to-house    canvass    by    University    students    showed    954    wells    still    used    in 
Ithaca.      Note    the    preponderance   in   the    Inlet    district.      Ward    One    has    over 
ten  times  as  many  wells  per  1,000  population  as  Ward  Four.     In  a  city,  wells 
are   to   be   regarded   with   suspicion. 

PRIVIES,    ITHACA,    JANUARY,    1914 


Ward 

1 
2 
3 
4 
5 

City 


umber 

Per  cent 

Per  1,000 

of  total 

population 

303 

46.2 

113 

83 

12.7 

32 

123 

18.8 

43 

28 

4.3 

8 

118 

18.0 

31 

655 


100.0 


42 


19 


Wells  are  evidently  more  numerous  than  -privies,  although  the  latter 
are  used  by  something  like  a  fifth  of  the  population.  The  distribution  of 
both  is  very  much  the  same — relatively  more  numerous  on  West  Hill  and 
in   the   lowlands   around   the   Inlet. 

The  remarkable  correspondence  between  the  distribution  of  Ithaca's  wells 
and  privies  and  her  residual  typhoid  has  already  been  pointed  out  (pages 
10-11),  and  it  is  undoubtedly  true  that  much  of  the  correspondence  partakes 
of  the  nature  of  cause  and  effect.  To  give  the  devil  -his  due,  however,  it 
must  not  be  assumed  that  every  insanitary  privy  or  every  polluted  well  is 
always  infectious.  Only  when  -portions  of  the  discharges  from  persons  with 
intestinal  diseases  reach  these  sanitary  makeshifts  is  actual  danger  present. 
A  community  almost  always  contains,  however,  persons  afflicted  with  these 
diseases,  some  of  Whom  are  not  inconvenienced  thereby  and  show  no  symp- 
toms. Thus  at  some  time  or  other,  in  the  long  run,  a  privy  will  receive  in- 
fectious material,  whereupon  the  danger  becomes  acute.  The  -potential  dan- 
ger to  the  whole  community  is  proportional,  of  course,  to  the  number  of  op- 
portunities offered;   -that  is,  the  number  of  wells  and  privies  existing. 

MAP  III. 


LOCATION    OP    PRIVIES,    ITHACA,    JANUARY,    1914 
The    same    canvass    showed    655    privies.      The    health    officer    states    that    since   that 
time    200    have    been    done    away    with.      This    policy    certainly    should    be    con- 
tinued,  as   the  privy  has  no  proper  place   in   city  life. 

Many  of  the  wells  in  Ithaca  undoubtedly  furnish  water  of  good  character; 
some  of  them  probably  at  all  times;  others  at  most  times.  A  small  per  cent" 
of  them,  however,  are  undoubtedly  always  polluted.  The  point  of  the  matter 
is  that  both  wells  and  privies  are  sanitary  makeshifts,  and  are  country, 
rather  than  city,  devices.  In  the  city  the  opportunities  for  well  pollution 
are  enormously  increased,  as  are  the  possibilities  of  fly  infection  from  privies. 
As  has  been  pointed  out,   many   residents  of  Ithaca  probably  are  prejudiced 

20 


against  the  city  water  supply  on  account  of  the  typhoid  epidemic  of  eleven 
years  ago;  but  it  must  he  reiterated  here  that  cases  are  now  reversed,  and 
that  the  city  water  supply  deserves  to  he  trusted  and  wells  to  he  regarded 
with  suspicion. 

The  defense  for  privies  is  weaker  than  that  for  wells.  In  places  where 
sewers  are  in  the  street,  privies  absolutely  should  not  be  tolerated.  This 
would  mean  in  Ithaca  the  elimination  of  practically  all  privies  on  the  east 
side  of  the  Inlet.  Some  200  privies  were  condemned  in  1913,  and  this  policy 
should  be  continued  with  vigor.*     A  large  part  of  the  city's  privies  can  be 


DANGEROUS  WELLS  AND  PRIVIES  IN  ITHACA 
The  illustrations  show  typical  Cliff  Street  well  and  privy.  The  privy  was  entirely 
open  in  the  rear  and  was  flooded  by  the  water  appearing  in  the  foreground. 
Infectious  matter  deposited  in  such  a  privy  has  ample  opportunity  to  reach 
new  victims.  The  survey  inspection  showed  954  wells  and  655  privies  in 
Ithaca. 

eliminated  in  this  way;  while  in  other  districts  the  sewer  and  water  sys- 
tems should  ibe  extended,  or  privies  should  be  required  to  be  properly  screened 
and  otherwise  made  sanitary.  A  sewer  on  Cliff  Street,  where  city  water  is 
already  available,  is   certainly  a  necessity. 


It   is   stated   that  there  are  now    (June   1915),   less   than   75   privies   at   places   where 
it   is  possible  to   connect  with  a  sewer. 

21 


Water  Supply 

Ithaca's  water  supply  is  taken  from  Six  Mile  Creek,  whose  watershed 
is  of  rather  small  size  and  characterized  by  a  quick  run-off.  In  times  of 
storm  the  creek  water  rapidly  becomes  very  turbid,  making  its  nitration  a 
somewhat  delicate  matter.  The  territory  drained  is  agricultural,  containing 
a  number  of  small  towns  which  have  no  sewer  systems.  As  a  result  of  the 
typhoid  epidemic  of  1903  inspections  were  made  of  the  water-shed,  the  obvious 
sources  of  pollution  were  removed,  and  nitration  works  of  the  rapid  mechani- 
cal variety  were  installed.  Typhoid  fever  has  since  that  time,  as  we  have 
seen,  been  "residual,"  or  non-waterjborne. 

The  sanitary  character  of  'the  water  before  and  after  treatment  is  in- 
dicated in  the  table  below,  compiled  from  reports  on  file  in  the  city  clerk's 
office.  The  indication  is  that  the  filters  are  receiving  a  water  that  is  pretty 
uniformly  objectionable  and  turning  out  one  that  is  uniformly  good.  The 
colon  bacillus,  the  typical  intestinal  organism  which  is  almost  always  present 
in  the  raw  water,  has  only  appeared  in  the  filtered  effluent  at  rare  intervals. 

BACTERIA    PER    CUBIC    CENTIMETER    IN    ITHACA    WATER,    1913a 


Raw  Water 

Filtered  Water 

Month 

At  20°  C. 

[      At  37°  C. 

At  20°  C. 

I    At  37°  C. 

Maximum  at  37°  C. 

January 

February 

March 

5,950 

2,390 

17,400 

1,790 

490 

1,760 

80 

62 

207 

15 

17 
32 

42  (14  analyses) 
130   (12          "        ) 
110   (13          "        ) 

April 

May 

June 

-370 
790 
860 

28 
170 
205 

22 

37 

140 

3 

7 

33 

12   (12          "        ) 

35   (13          "        ) 

110  (13          "        ) 

July 

August 

September 

780 
415 
263 

145 

170 

61 

390 

51 

3 

30 
7 
0 

90   (13          "        ) 

38   (16          "        ) 

0(9          "        ) 

October 

November 

December 

600 

2,530 
360 

240 

770 
60 

40 

450 

23 

12 

185 

q 

60  (  5          "        ) 

700   (4                   ) 

10   (4                   ) 

It  should  be  noted,  however,  that  the  filter  plant  is  now  operated  at  fu 
capacity  fairly  often,  and  that  if  a  large  fire  should  break  out  at  such  times 
the  water  would  have  to  pass  through  unfiltered.  Such  a  condition  actually 
arose  twice  in  the  last  three  years.  The  filters  have  a  designed  capacity  of 
3,500,000  gallons  a  day  and  usually  operate  at  the  rate  of  about  2,500,000.  At 
the  same  time  it  has  been  estimated  that  leakage  and  wastage  in  the  distribu- 
tion system  amount  to  800,000  to  1,000,000  gallons  a  day,  a  loss  which  meter- 


Monthly  average  of  counts  by  Nelson  &  Lauder,  Binghamton,  N.  Y.  All  samples 
taken  at  filtration  plant ;  those  of  filtered  water  from  the  clear -water  well. 
Samples  iced  and  sent  to  Binghamton ;  with  one  or  two  exceptions  analyzed 
the  same  day  as  taken.  Hypochlorite  used  for  two  months  commencing  the 
middle    of   August. 


22 


ing  would  do  much  to  reduce.  At  all  events,  some  provision  should  be  made  to 
allow  for  a  much  larger  margin  of  safety  as  between  consumption  and  capa- 
city. 

More  liberal  provision  should  also  be  made  with  regard  to  laboratory 
facilities  at  the  plant  and  in  the  matter  of  superintendence.*  In  the  event  of 
disability  of  the  present  capable  filter  superintendent  the  city  would  be  em- 
barrassed for  lack  of  a  competent  understudy.  The  health  officer's  suggestion 
that  such  a  person  be  provided  is  an  excellent  one.  The  lesson  of  1903 — that 
the  filter  stands  between  the  city  and  pos-sible  epidemic — must  not  be  forgotten; 
nor  that  the  quick  run-off  of  the  water-shed,  and  the  consequently  changeable 
character  of  the  creek  water,  demands  careful  supervision  at  the  plant. 

The  advisability  of  disinfecting  the  supply  with  chlorine  subsequent  to  fil- 
tration is  also  suggested.  During  the  fall  of  1913  such  disinfection  was  em- 
ployed to  cover  a  temporary  condition  of  filter  inefficiency.  Devices  are  now 
on  the  market  by  which  the  whole  supply  may  be  disinfected  at  very  slight 
cost,  and  an  extra  margin  of  safety  secured.  The  process  is  entirely  harmless, 
and  the  chances  of  a  failure  in  purification  are  rendered  only  one-quarter  as 
great.  It  may  be  objected  that  disinfection  tends  to  make  filter  operators  care- 
less and  that  an  overdose  of  chlorine,  with  resulting  noticeable  taste,  would 
revive  prejudice  against  the  city  water.  With  proper  equipment  such  an  occur- 
rence should  be  easily  preventable,  while  efficiency  of  filtration  may  be  main- 
tained, as  at  present,  by  analyzing  samples  of  filtered  water  before  the  addition 
of  the  disinfectant.  At  the  very  least,  an  emergency  disinfection  apparatus,  in 
good   condition,   should   be   available   at   all  times. § 

Cornell  University  provides  its  own  water  supply,  drawing  on  Beebe  Lake. 
The  supply  is  of  the  same  general  character  as  that  of  the  city,  and  a  similar 
filtration  process  is  employed.  In  addition,  this  water  is  disinfected  at  all  times. 
While  figures  as  to  the  efficiency  of  the  University  plant  were  not  readily 
available  at  the  time  of  the  survey,  the  general  character  of  the  plant  and 
the  freedom  from  disease  of  consumers  of  the  water  argue  for  the  satis- 
factory quality  of  the  latter. 

Sewerage  and   Sewage   Disposal 

The  city  is  now  equipped  with  a  fairly  comprehensive  system  of  sewers, 
the  chief  deficiencies  being  on  the  west  side,  especially  on  Humboldt  and 
Cliff  Streets.  A  description  of  the  system,  and  of  the  sewage  treatment  works, 
may  be  found  in  Professor  H.  N.  Ogden's  report  on  sanitary  conditions  in 
Ithaca,  f     For  the  present  purpose  it  is  sufficient  to  note  the  extensive  char- 


it   is   stated   that   this   need   is   now   met. 


§  In  the  year  subsequent  to  the  writing  of  this  paragraph  arrangements  were  made 
so  that  Ithaca's  water  supply  now  has  the  added  safeguard  of  chlorination. 
A   number    of   water    main    extensions    also    have   been    made. 


30th   Annual    Report   of   the   New   York    State   Department    of   Health,    1909,    Volume 
2,   p.    780. 

23 


acter  of  the  system,  to  urge  that  connection  with,  it  be  forced,  and  to  sug- 
gest the  construction  of  sewers  on  West  Hill.* 

The  treatment  works  consist  of  a  large  septic  tank,  located  in  the  north- 
west part  of  the  city  near  the  point  where  Cascadilla  Creek  enters  the 
Inlet.  After  passing  slowly  through  the  tank  the  sewage  is  discharged  into 
the  Inlet  at  a  point  nearby.  The  original  method  of  pumping  the  sewage  out 
into  the  lake  has  been  entirely  discontinued,  and  with  the  recent  change 
in  the  Inlet  channel  the  outfall  no  longer  extends  into  the  current,  a  cir- 
cumstance which  is  apt  to  cause  local  nuisance.  It  should  be  borne  in 
mind  that 'the  present  treatment  in  the  septic  tank  is  simply  reduction  and 
not  purification.  Solid  material  in  the  sewage  is  liquefied  by  such  a  pro- 
cess but  the  effluent  is  not  rendered  stable,  i.  e.,  unputrefiable,  nor  are  the 
potential  dangers  from  disease  germs  removed.  While  no  great  harm  seems 
to  have  resulted  from  the  discharge  of  the  unpurified  sewage  into  the  Inlet, 
the  city  must  bear  in  mind  the  possibility  that  purification  may  after  all 
prove    desirable   or   may  at   some   time  be    commanded   by   state    authorities. 


SANITARY    CONDITIONS    IN    ITHACA 
West    Hill,    showing   Hector   Street   above    and    Cliff   Street   below.      Cliff    Street    has   a 
water   main    but   no    sewer ;    both    streets    have   many    wells    and    privies.      Note 
the  opportunity  for  pollution  of  Cliff  Street  wells  by  habitations  above. 


V.      CITY     HEALTH     DEPARTMENT 

Organization 

From   what   has    already   been    said    it    is    apparent    that   there   is    much 
to    commend    in   the    existing  city   health   work.      The    board    seems    to    have'^ 
acted    with    unusual    intelligence,    and    the    health    officer    with    unusual    con- 
scientiousness  and    energy.     While   the   board    system   has   in   general   fallen 


*  A  number  of  sewer  extensions  have  been  made.     More  than  half, of  Humboldt  Street 
is  now  said   to  be  sewered. 

24 


into  disrepute,  it  must  b'e  admitted,  that  Ithaca  does  not  seem  to  have  suf- 
fered from  this  method  of  health  department  management.  Possibly  this 
is  because  the  board  has  had  among  its  members  University  professors  with 
special  knowledge  of  health  work.  It  is  perhaps  an  illuminating  commentary 
on  the  board  system  that  when  an  unusually  intelligent  board  exists,  as  in 
Ithaca,  it  illustrates  its  capacity  by  giving  the  health  officer  a  pretty  free 
hand.  Such  has  been  the  local  state  of  affairs,  and  the  results  have  been 
gratifying. 

Improvement  can  be  secured,  however,  if  not  through  changes  in  form 
of  organization,  at  least  through  an  increase  in  quantity  of  service  provided. 
The  health  officer  is  at  present  employed  on  part  time,  and  is  engaged  in 
the  active  practice  of  medicine.*  In  addition,  'he  must  act  as  his  own  con- 
tagious disease  investigator,  statistician,  clerk  and  executive.  These  de- 
mands are,  under  the  conditions,  relatively  greater  than  can  be  met  with  com- 
pleteness. As  a  result,  the  office  must  try  to  meet  the  more  insistent  needs 
and  pass  over  matters  that  appear  to  be  of  minor  importance.  It  is  an 
arrangement  which  makes  against  good  record  keeping  and  the  initiation  of 
new  work. 

The  answer  to  this  problem  is,  in  most  cities,  the  employment  of  a  full- 
time  health  officer  and  the  provision  of  proper  clerical  and  nursing  assistance. 
In  Ithaca  the  question  is  Whether  a  full-time  man  could  be  obtained  who 
would  equal,  in  intelligence,  energy,  and  knowledge  of  local  conditions,  the 
present  health  officer.  Whatever  solution  is  attempted  the  health  officer 
should  be  given  more  assistance,  probably  best  in  the  form  of  a  public  health 
nurse.  Such  a  person  would  be  useful  in  tuberculosis  and  other  communica- 
ble disease  work,  in  combating  infant  mortality,  and  in  the  keeping  of  suita- 
ble records. 

Financial    Treatment 

The  amount  of  work  which  a  health  department  can  do,  or  be  expected 
to  do,  depends,  of  course,  upon  the  amount  of  money  it  is  allowed.  Bricks 
cannot  be  made  without  straw,  nor  can  effective  disease  prevention  work  be 
carried  on  without  money.  The  expenditures  of  Ithaca's  department  for  the 
last  two  years  are  as  follows: 

EXPENDITURES   OF   THE    BOARD    OF    HEALTH,    ITHACA,    1912   AND    1913 

Salaries  1912                                 1913 

Health    officer     $1,000                              $1,000 

Sanitary    inspector    420                                  420 

Bacteriologist    250                                  240 

Office   clerk    180                                 180 

Dairy    and    food    inspector 612.50  $2,462.50          900          $2,740.00 


*  This  is  no  longer  true.  The  health  officer  now  devotes  all  his  time  to  public 
health  work,  partly  as  city  health  officer  and  partly  as  district  supervisor  for 
the  State  Department  of  Health.  This  arrangement  offers  many  advantages. 
In    addition   the    city   now    employs    a   full-time    sanitary    inspector. 

25 


Contagious  Diseases 

City  Hospital — care  of  patients...     1,144  227 

Supplies   and   expenses    633.73       1,777.73  215.64  442.62 

Miscellaneous 

Tuberculosis  dispensary  —  salary 

and    expenses    1,113.72  1,062.17 

Registration   fees    390.30  60.58 

Mosquito    work    201.99  241.85 

Dairy   scores,    milk   analyses,   and 

expenses     202.25  0 

Milk  inspection   and   analyses....  0  661.75 

Postage,  stationery,  office  ex- 
penses       41.15       1,949.41  68.60       2,094.95 

Total     $6,189.64  $5,277.59 

The  total  expenditure  for  these  two  years  gives  an  average  yearly  ex- 
penditure of  about  38  cents  for  each  inhabitant.  This  is,  as  health  depart- 
ment appropriations  go,  a  fairly  liberal  allowance;  but  is  in  no  way  ex- 
cessive, as  recommendations  for  a  minimum  per  capita  expenditure  have 
varied  from  50  cents  to  $1.00.  On  the  whole,  however,  the  city  is  to  be 
congratulated  on  the  far-sighted  policy  which  it  has  inaugurated,  and  it  is 
to  be  hoped  that  this  policy  of  reasonable  health  investment  will  be  con- 
tinued   and    extended. 

Milk    Inspection 

Among  the  commendable  services  which  the  local  health  department 
has  initiated  is  that  for  the  inspection  of  dairy  farms  and  milk.  An  ar- 
rangement exists  between  the  city  and  the  College  of  Agriculture  in  Cornell 
University,  whereby  samples  are  examined  in  the  University  laboratories.  The 
arrangement  included,  in  the  past,  the  scoring  of  dairy  farms,  but  this  work 
is  now  carried  on  by  the  city  food  inspector.*  The  results  of  the  work  are 
gratifying,  as  is  indicated  in  the  table  below. 

RESULTS  OF    MILK    EXAMINATIONS,    ITHACA,    1907-1913* 

Year  Number  of   samples  Average   bacterial   count 

1907-8  152  707,780 

1908-9  150  370,760 

1909-10  148  221,000 

1910-11  179  187,000 

1912  438  326,000                                    j£ 

1913  822  347,300 


*  Since  this  sentence  was  written  the  old  arrangement  has  been  restored,   dairy  farms 
again  being  inspected  by  representatives  of  the  University. 


B   Figures  furnished  by  Prof.  W.  A.  Stocking,  Jr.     Counts  on  agar  at  37°  C  and  48  hours. 

26 


.  Not  only  is  the  general  average  distinctly  good,  but  a  very  large  pro- 
portion of  the  samples  taken  in  1913  gave  a  result  meeting  the  require- 
ments of  certified  milk.  This  fact  is  brought  out  in  the  table  below,  40  per 
cent  of  the  samples  giving  counts  of  less  than  10,000  per  cubic  centimeter, 
66  per  cent,  counts  under  50,000. 

RESULTS    OF    MILK    EXAMINATIONS    BY    MONTH    AND    BACTERIAL 
CONTENT,    ITHACA,    1913a 


Number  of  samples 

total 

not 
counted 

1 

with  counts 

Month 

below 
10,000 

1      10,000- 
1      50,000 

50,000- 
100,000 

100,000- 
500,000 

500,000- 
1,000,000 

over 
1,000,000 

Jan. 
Feb. 
Mar. 
Apr. 

28 
26 
25 
54 

1 

0 

1 
1 

9 
16 

6 
24 

9 

6 

11 

13 

3 

1 
1 

0 

2 
0 
6 
3 

4 
3 
0 
1 

0 

0 

0 

12 

May 
June 
July 
Aug. 

59 
51 

57 
26 

0 
3 
1 
0 

35 

14 

19 

9 

11 

13 

15 

4 

3 

7 
3 
4 

7 
5 
4 
5 

0 
3 
3 
0 

3 

6 

12 

4 

Sept. 
Oct. 

Nov. 
Dec. 

42 
118 
127 
108 

16 

0 
0 
3 

15 
37 

67 
40 

6 
35 
26 
36 

3 
20 
11 
12 

2 
13 
17 
11 

0 

7 
0 

2. 

0 
6 
6 
5 

Total 

721 

26 

291 

184 

68 

75 

23 

54 

Per  cent 

100.0 

3.6 

40.4 

25.5 

9.4 

10.4 

3.2 

7.5 

The  counts,  as  might  be  expected,  show  a  tendency  to  run  up  in  the 
warm  summer  months,  but  the  general  showing  is  still  good.  The  average 
count  would  be  even  better  were  it  not  for  a  small  number  of  quite  high 
counts,  the  presence  of  which  indicates  that  the  milk  problem  is  not  yet  en- 
tirely solved.  The  increased  effort  should,  in  all  probability,  be  along  the 
line  of  more  frequent  dairy  inspections,  since  the  food  inspector  in  the  last 
year  made  86  inspections,  a  number  Which  would  not  quite  cover  all  the 
dairy  farms  once.  The  results  of  the  farm  inspections,  made  with  the  United 
States  Department  of  Agriculture  score  card,  is  as  follows: 


a  Figures  furnished  by  Prof.  W.  A.  Stocking,  Jr.     Counts  on  agar  at  37°  C  and  48  hours. 

27 


DAIRY    SCORES,    ITHACA,    1913 
Figures   furnished    by    city    food    inspector 


Scoring 

N 

umber 

of 

farms 

Per 

cent  of  total 

90-100 

2 

2.3 

80-90 

16 

18.6 

70-80 

35 

40.7 

60-70 

25 

29.1 

50-60 

7 

8.1 

40-50 

1 

1.2 

Total  86  100.0 

The  showing  is  again  good,  as  few  very  high  scores  are  made  with  the 
government  card,  and  as  the  latter  is  rather  severe  on  the  small  farms — 
even  when  clean.  One  strong  point  in  the  present  dairy  inspection  is  the 
thorough  physical  examination  given  all  cows  each  year.  In  1913,  of  1,419 
cows  examined  22  were  condemned  on  account  of  local  or  general  disease 
and  were  removed  from  the  herds. 

Altogether  the  Ithaca  milk  supply  is  a  good  example  of  what  can  be 
accomplished  by  judicious  inspection  carried  on  without  any  great  amount 
of  agitation  and  with  very  little  inconvenience  to  producers.  Dairy  farms 
and  milk  both  show  up  well;  about  half  the  milk  is  sold  in  bottles;  and  about 
15  per  cent  is  pasteurized.  A  few  bad  spots  exist,  but  they  can  be  eliminated 
by  the  continuation  of  the  present  work  with  some  amplification — such  as 
more  frequent  dairy  inspections.  Pasteurization  of  this  clean  supply  would 
provide  an  added  safeguard,  but  the  local  situation  presents  peculiar  difficul- 
ties in  this  connection,  owing  to  the  relatively  large  number  of  independent 
producer-dealers.  A  word  of  praise  must  be  given  the  health  department's 
initiation  of  a  policy  of  useful  milk  publicity,  a  list  of  dealers  with  their  dairy 
scores  and  milk  counts  for  the  summer  of  1913  appearing  in  the  Ithaca  San- 
itary Bulletin,  whose  first  issue  appeared  December  15,  1913. 

Food    Inspection 

Since  June  15,  1912,  the  health  department  has  employed  a  part-time  food 
inspector.*  The  duties  of  this  official  were  at  the  start  limited  to  the  inspec- 
tion of  meat  markets,  restaurants,  and  other  places  where  food  is  handled 
or  sold,  but  during  1913  they  were  extended  to  include  the  inspection  of 
dairy  farms.  The  nature  and  extent  of  the  work  is  indicated  below,  the  fig- 
ures being  taken  from  the  inspector's  annual  report. 


*  Now  discontinued,  an  arrangement  having  been  made  whereby  the  city's  food  in- 
spection is  carried  on  by  the  Colleges  of  Agriculture  and  Veterinary  Medicine  of 
the  University. 

28 


FOOD    INSPECTION,    ITHACA,    1913 

Beeves   inspected    718       Dairies  condemned 3 

Beeves    condemned    28  Cows     given    physical     examina- 

Entire    carcasses    condemned.  .  .  15          tion    1419 

Separate  carcasses  condemned..  18       Cows  condemned    22 

Hogs    inspected     1034  Cows  condemned  for  general  dis- 

Hogs    condemned    12          ease   14 

Dairies   inspected   and   scored.  .  .  83  Cows  condemned  for  local  disease  8 

In  addition  to  the  work  listed  above,  the  inspector  makes  frequent  visits 
to  14  markets,  17  restaurants,  19  student  boarding  houses,  8  bakeries,  3  fish 
markets,  and  a  number  of  confectioneries. 

Perhaps  one-tenth  of  the  city's  meat  supply  is  locally  slaughtered,  in  three 
slaughter  houses.  With  the  other  demands  on  his  time,  the  inspector  is  un- 
able to  see  these  animals  on  the  hoof,  or  to  be  present  at  the  time  of  killing, 
thus  having  to  be  content  with  the  less  valuable  examination  of  carcasses 
and  entrails.  Altogether  the  food  inspector  has  more  work  to  perform  than 
his  part-time  employment  allows;  but  it  would  appear  that  much  useful 
work  is  being  accomplished  and  it  is  obvious  that  the  city  can  have  more 
if  it  will  pay  the  price. 

Control    of    Communicable    Diseases 

Discussion  has  already  been  given  to  the  procedures  employed  in  the 
control  of  tuberculosis  and  typhoid  fever  and  suggestions  have  been  made 
looking  toward  a  program  for  the  control  of  venereal  diseases.  Considera- 
tion now  will  be  given  to  the  health  department's  routine  efforts  for  the 
control  of  communicable  diseases — certainly  one  of  its  most  important  func- 
tions. 

The  present  quarantine  regulations  for  the  common  contagious  diseases 
are  commendable.  In  scarlet  fever  the  health  officer  sees  every  case,  except 
those  among  students,  at  the  first  notification  and  before  release  from  quar- 
antine. In  no  case  is  the  quarantine  period  less  than  three  weeks,  and  the 
condition  of  the  patient  with  regard  to  release  is  judged  largely  by  the  ap- 
pearance of  the  throat.  In  private  houses  quarantine  is  very  strict,  both 
the  patient  and  his  attendants  being  isolated  from  the  general  public. 

The  same  general  rules  are  laid  down  for  diphtheria,  with  the  exception 
that  two  negative  cultures  from  the  throat  are  required  before  the  patient 
is  released.  If  a  positive  culture  is  secured,  three  days  must  elapse  before 
the  next  culture  may  be  taken.  All  cultures  are  taken  by  the  health  of- 
ficer. The  use  of  milk  tickets  is  forbidden  in  either  disease  and  the  milk- 
men are  not  allowed  to  leave  bottles  at  the  house  in  which  the  case  exists. 
After  quarantine  is  raised  in  scarlet  fever,  10  days  must  elapse  before  the 
patient  can  mingle  with  other  children;  in  diphtheria  this  period  is  seven 
days.  Fumigation  with  formaldehyde,  and  what  is  more  important,  surface 
disinfection  with  liquids,  are  practiced  at  the  termination  of  the  case. 

29 


In  measles,  the  child  is  excluded  from  school,  as  are  all  contacts  who  have 
not  had  the  disease.  The  same  procedure  obtains  in  German  measles  and 
whooping  cough. 

Reporting  of  cases  in  diphtheria  and  scarlet  fever  is  stated  to  be  slower 
than  is  desirable,  as  is  the  case  with  typhoid  fever.  Cases  of  these  diseases 
seen  by  physicians  are  usually  reported  eventually,  but  for  the  best  results 
it  is  exceedingly  desirable  that  reports  be  prompt,  and  public  opinion  should 
require  this.  Tuberculosis  is  reported  well,  measles  and  whooping  cough  to 
a  fair  degree,  and  pneumonia  and  cancer  not  at  all. 

Good  facilities  for  laboratory  diagnosis  are  available,  due  largely  to  the  pres- 
ence of  the  University.  Diphtheria  cultures  receive  prompt  attention,  and 
free  examinations  of  specimens  also  are  made  for  tuberculosis,  typhoid  fever, 
rabies,  and  malaria.  Free  tetanus  and  diphtheria  antitoxins  are  likewise  dis- 
tributed. With  the  unusual  laboratory  facilities  available  it  is  suggested  that 
arrangements  be  made  for  free  examination  of  specimens  for  the  organisms 
of  gonorrhoea  and  syphilis,  to  include  both  microscopic  examinations  and  blood 
tests  for  complement  fixation. 

The  present  contagious  disease  hospital  facilities  at  the  old  contagious 
disease  annex  are  somewhat  inadequate,  and  the  hospital  trustees  propose  to 
build  a  pavilion  to  the  south  of  the  city  hospital  to  meet  the  need.  As  an 
alternative  it  has  been  suggested  that  alterations  be  made  in  the  old  con- 
tagious disease  hospital.  At  all  events  this  matter  should  be  settled  as  quick- 
ly as  practicable,  so  that  the  city  may  not  be  embarrassed  in  the  face  of  an 
unexpected    outbreak    of    contagion. 

This  inadequacy  in  hospital  facilities,  which  includes  lack  of  provision 
for  cases  of  smallpox,  and  the  previously  noted  lack  of  adequate  provision  for 
the  reinspection  of  quarantine  and  the  supervision  of  typhoid  cases  are  the 
most  serious  deficiencies  in  the  city's  service  for  restriction  of  the  communi- 
cable diseases.  It  is  suggested,  however,  that  this  service  might  be  materially 
strengthened  by  a  move  in  a  new  direction;  that  is,  by  the  establishment  of 
a  health  department  dispensary.*  The  latter,  conducted  on  modern  lines,  with 
a  nurse  to  visit  patients  in  their  homes  and  to  investigate  their  financial  cir- 
cumstances, would  offer  better  medical  relief  to  the  indigent  and  would  help 
the  health  department  in  its  work  against  infant  mortality,  tuberculosis,  and 
the  venereal  and  other  communicable  diseases.  The  sick  poor  are  more  will- 
ing to  avail  themselves  of  such  a  service  as  compared  with  the  old  style  poor 
relief,  while  the  health  authorities'  chances  of  discovering  and  eliminating 
centers  of  infection  are  greatly  increased  in  its  administration. 

Infant    Mortality 

The  mortality  of  infants  in  their  first  year  of  life  is  one  of  the  most  im- 
portant of  all  sources  of  mortality;  it  is  especially  important  from  the  stand* 
point  of  prevention.  In  Ithaca  24  infants  died  during  1913  before  reaching  their 
first  birthday.     In  the  same  year  276  were  born,  giving  an  infant   death  rate 


*  The  City  Health  Department  now  maintains  a  dispensary  for  tuberculosis  and  infant 
mortality. 

30 


of  87.0  per  1,000  births,  a  figure  considerably  lower  than  those  of  most  urban 
communities.  This  does  not  mean,  however,  that  preventable  deaths  do  not 
occur  among  Ithaca's  infants:  it  is  entirely  probable  that  such  deaths  do  oc- 
cur in  certain  parts  of  the  city,  and  that  the  usual  baby-saving  work  would 
produce  valuable  results. 

Important  causes  of  much  of  this  infant  sickness  and  death  are  intes- 
tinal infections,  the  overheating  of  infants  during  the  hot  summer  weather, 
and  improper  feeding  and  general  care.  These  are  conditions  that  yield  to 
educational  procedures  such  as  can  be  carried  out  by  public  health  nurses 
and  baby  welfare  stations.  Midwives  also  need  supervision.  All  these  mat- 
ters should  receive  attention  from  Ithaca's  health  department,  as  this  field 
assuredly  offers  one  of  the  greatest  opportunities  for  effective  disease  pre- 
ventive effort.* 

It  is  earnestly  hoped  that  the  brevity  of  the  present  discussion  will  not 
be  taken  as  a  measure  of  the  relative  importance  of  the  subject.  An  inten- 
sive study  of  Ithaca's  infant  mortality  by  district,  cause,  and  year,  is  not 
presented  here  simply  for  the  reason  that  in  the  short  time  available  for 
the   survey  it  was   impossible   to  gather   the    necessary   data. 

Publicity   and    Education 

Another  important  field  for  her  progress  in  which  Ithaca  may  be  praised 
is  health  education  and  publicity.  Issue  number  one  of  the  "Ithaca  Sani- 
tary Bulletin"  appeared  on  December  15,  1913.  Not  only  is  this  a  step  in 
the  right  direction  but  it  has  been  taken  in  the  right  way:  the  Bulletin 
is  no  meaningless  list  of  more  or  less  insignificant  statistics,  but  gives  a 
readable  discussion  of  the  city  milk  supply,  with  the  scores  and  analytical 
results  corresponding  to  the  various  dairymen,  and  several  interesting  notes 
on  other  sanitary  subjects.  Certainly  this  commendable  innovation  should 
be  continued  and  developed.  Plans  for  lectures  and  exhibits  should  also  be 
considered;  for  modern  public  health  work,  after  the  more  obvious  menaces 
have  been  abated,  must  be  to  a  large  extent  an  educational  campaign,  and 
must  have  the  appreciation,   support,   and   co-operation  of  the   public. 

Record    Keeping 

Such  favorable  criticism  cannot  be  given  the  present  methods  of  col- 
lecting and  preserving  sanitary  records  and  statistics.  The  register  of  tuber- 
culosis cases  is  in  good  order,  but  the  records  of  other  communicable  dis- 
eases suffer  from  the  limitations  on  the  health  officer's  time  and  his  lack 
of  adequate  clerical  assistance.  If  such  assistance  is,  as  should  be,  furnished, 
the  present  records  can  be  kept  with  greater  completeness,  and  new  ones, 
such  as  adequate  case  histories,  can  be  kept  which  will  be  of  much  real 
value.  In  the  more  painstaking  and  detailed  work  necessary  for  the  elimina- 
tion of  "residual"  sickness,  careful  record-keeping  becomes  of  increased  im- 
portance. 


*  Since   the   preparation    of   this    report    the    health    department    has    opened    an   infant 
welfare    station. 

31 


VI.     SUMMARY    AND    CONCLUSIONS 

Ithaca's  sanitary  conditions  and  her  general  and  specific  death  rates  are, 
on  the  whole,  better  than  the  average.  The  big  public  sanitary  improve* 
ments  have  been  made,  and  the  big  excesses  of  preventable  disease  have  dis- 
appeared. Her  public  health  problem  now  consists  in  grappling  with  newly 
discovered  opportunities,  such  as  the  restriction  of  venereal  diseases  and  in- 
fant mortality;  and  in  the  elimination  of  the  "residuals"  of  the  other  com- 
municable   diseases. 

In  mseting  this  problem  some  changes  must  be  worked  in  the  inanimate 
environment,  such  as  the  elimination  of  privies,  and  the  extension  of  parts 
of  the  sewer  and  water  systems;  the  main  reliance,  however,  must  be  placed 
in  an  augmented  health  department,  one  that  can  discover  the  sources  of  in- 
fection promptly,  and  can  prevent  its  spread.  Such  a  program  requires 
much  closer  supervision  of  infected  individuals,  and,  therefore,  increased 
and  properly-qualified  assistance  for  the  health  officer.  The  expense  of  such 
a  program,  when  compared  with  that  for  public  improvements,  such  as  Ithaca 
has  been  forced  to  meet  in  the  past,  is  fortunately  not  great. 

In  accordance  with  the  foregoing  the  following  recommendations  are  of- 
fered: 

1.  That  steps  be  taken  to  eliminate  all  privies  where  sewers  and  city 
water  are  available;  and  that  owners  of  other  privies  be  compelled  to  keep 
them  in  a  sanitary  manner;  that  is,  so  as  to  prevent  pollution  of  the  soil 
and  the  entrance   of  flies  and  other  animals. 

2.  That  the  use  of  wells  be  discouraged,  and  that  those  in  which  there 
is   evident   opportunity   for,   or   evidence  of  pollution,   be   condemned. 

3.  That  sewers  and  city  water  be  extended  in  a  liberal  manner,  especial- 
ly to  include  certain  districts  west  of  the  Inlet.* 

4.  That  measures  be  taken  to  assure  a  larger  margin  of  safety  as  be- 
tween water  consumption  and  the  capacity  of  the  water  filtration  plant;  that 
a  more  liberal  laboratory  equipment  be  provided  at  the  plant;  and  that  provi- 
sions be  made  to  insure  a  high  grade  of  supervision  at  all  times.  The  de- 
sirability of  securing  the  additional  safeguard  obtainable  by  chlorine  disinfec- 
tion is  also  suggested. § 

5.  That  additional  assistance  be  furnished  the  health  officer,  probably 
best  in  the  form  of  clerical  service  and  a  public  health  nurse,  or  nurses; 
this  assistance  to  be  utilized  in  the  closer  supervision  of  quarantine,  and  in 
work  against  infant  mortality,!  tuberculosis,  and  other  communicable  dis- 
eases. 

6.  That  closer  supervision  be  exercised  over  persons  ill  with  typhoid 
fever,  and  that  the  power  of  removal  be  secured  and  exercised  when  neces- 
sary. 


*  See  note  on  page  24. 
§  See  note  on  page  23. 


t  See  note  on  page   30. 

32 


7.  That  the  present  work  against  tuberculosis  be  continued,  supplemented 
by  more  nursing  assistance,  increased  facilities  for  the  dispensary,  and  in- 
creased   accommodations   at   the    sanatorium.* 

8.  That  the  health  department  initiate  work  against  the  venereal  dis- 
eases, requiring  reporting  (by  number  instead  of  name  if  so  desired),  offer- 
ing free  laboratory  diagnosis,  securing  early  free  treatment  for  the  indigent, 
and  carrying  on  a  campaign  of  educational  publicity. 

9.  That  the  present  work  for  milk  inspection  be  continued  on  a  some- 
what enlarged  scale;  and  that  more  time  be  allotted  to  the  work  for  food 
inspection. 

10.  That  the  health  department's  commendable  start  on  health  publicity 
and   education   be   continued  and   extended. 

11.  That  provision  be  made  for  the  keeping,  in  the  health  department, 
of   more   complete   records. 


*  See  note   on   page    17. 

33 


Survey  Contributors 


Mr.    Earl   E.   Atkinson 
Prof.    L.    H.    Bailey 
Prof.    P.   Bedell 
Mrs.    Mary   E.    Bell 
Dr.  C.  P.  Biggs 
Dr.    L.    J.    Bingham 
Mrs.    H.    T.   Bull 
Prof.  G.  L.  Bun- 
Mr.   H.   G.   Carpenter 
Mrs.    R.    C.    Carpenter 
Prof.    I.    P.    Church 
Mr.   J.   M.    Clapp 
Prof.    J.    H.    Comstock 
Prof.    C.    L.    Crandall 
Prof.    T.    F.    Crane 
Dr.    H.    H.    Crura 
Prof.   L.  M.   Dennis 
Prof.  A.  B.   Faust 
Federation   of  Women's    Clubs 
Miss    Mary    S.    Finch 
First  Baptist.  Church,   Per  Rev.  R.  T. 

Jones 
Prof.  A.   C.  Gill 
Dean  E.   E.  Haskell 
Prof.   A.   Hayes 


Prof.   C.  H.  Hull 

Ithaca  Business  Men's  Association 

Prof.    H.    S.    Jacoby 

Mr.    S.   Jeffrey 

Prof.    A.    S.   Johnson 

Prof.   V.   Karapetoff 

Mr.   P.   S.   Livermore 

Mr.    James    Lynch 

Prof.   J.    McMahon 

Dr.    H.    E.   Merriam 

Prof.    E.   G.    Merritt 

Mr.   J.    T.    Newman 

Miss   M.    M.    Pitcher 

Mr.    J.    R.    Robinson 

Mr.    J.    Rothschild 

Mr.    C.    T.    Stagg 

Prof.   J.    H.    Tanner 

Mr.    C.    E.    Treman 

Mr.   R.  H.   Treman 

Hon.   A.   D.   White 

Misses  Williams 

Prof.  J.  A.  Winans 

Prof.    E.   H.   Woodruff 

Prof.   P.   Work 

Prof.  A.  A.  Young 


THE  ATKINSON  PRESS,  ITHACA 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
provided  by  the  library  rules  or  by  special  arrangement  with 
the  Librarian  in  charge. 


DATE  BORROWED 

DATE   DUE 

DATE  BORROWED 

DATE   DUE 

C28(842)M50 

ScfcS 
EA448 


